Texas Heart Institute journal
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Randomized Controlled Trial Comparative Study
Subxiphoid versus intercostal chest tubes: comparison of postoperative pain and pulmonary morbidities after coronary artery bypass grafting.
Chest tubes are one cause of pain after cardiac surgery. In a prospective, randomized study, we investigated the effects of the position of chest tubes on acute postoperative pain and pulmonary morbidities in patients who underwent coronary artery bypass grafting. From June through December 2010, 40 patients who underwent elective coronary artery bypass grafting were enrolled in the study. ⋯ Pleural effusion and atelectasis were each diagnosed in 3 patients in Group 1 (15%) and 1 patient in Group 2 (5%) (both P=0.68). Two of the patients in Group 1 required drainage of the pleural effusion. In our study, we found that the subxiphoid and intercostal approaches for chest-tube placement yielded similar clinical outcomes.
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Multicenter Study
Colombian experience with transcatheter aortic valve implantation of medtronic CoreValve.
At our institutions, increasing numbers of aortic stenosis patients were not candidates for surgical aortic valve replacement. Accordingly, we initiated the Cali Colombian Transcatheter Aortic Valve Implantation (TAVI) program. From March 2008 through January 2011, 53 consecutive patients (mean age, 79 ± 6 yr; men, 58%) underwent TAVI with the Medtronic CoreValve System, and data were prospectively collected. ⋯ Moderate or severe aortic regurgitation decreased from 32% to 18% (P=0.12) and mitral regurgitation from 32% to 13% (P=0.002). The 1-year survival rate was 81%. We found that TAVI with the CoreValve prosthesis was safe and feasible, with sustained long-term results, for treating aortic stenosis in patients at excessive surgical risk; nonetheless, serious adverse events occurred in 30% of the patients.
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Since the implantable cardioverter-defibrillator was first used clinically in 1980, several large randomized controlled trials have shown that therapy with this device can be beneficial in various patient populations. Evidence suggests that this therapy is useful in the secondary prevention of sudden cardiac death among patients who have survived arrhythmic events. ⋯ When used with cardiac resynchronization therapy, implantable cardioverter-defibrillators have improved survival rates and quality of life in patients with severe heart failure. Further research is needed to examine the potential benefits of implantable cardioverter-defibrillators in elderly, female, and hemodialysis-dependent patients, and to determine the optimal waiting period for implantation after myocardial infarction, coronary revascularization, and initial heart-failure diagnosis.
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Review Historical Article
Self-experimentation and its role in medical research.
Although experimentation involving human volunteers has attracted intense study, the matter of self-experimentation among medical researchers has received much less attention. Many questions have been answered only in part, or have been left unanswered. How common is this practice? Is it more common among certain nationalities? What have been the predominant medical fields in which self-experimentation has occurred? How dangerous an act has this proved to be? What have been the trends over time? What is the future likely to bring?From the available literature, I identified and analyzed 465 documented instances of this practice, performed over the course of the past 2 centuries. ⋯ Eight deaths were recorded. A number of the investigators enjoyed successful careers, including the receipt of Nobel Prizes. Although self-experimentation by physicians and other biological scientists appears to be in decline, the courage of those involved and the benefits to society cannot be denied.